Causes and Risks:

Elevated blood pressure increases the workload of the heart; over time, this results in thickening of the heart muscle. As the heart continues to pump against elevated pressure in the blood vessels, the left ventricle begins to dilate, cardiac output (the amount of blood pumped by the heart each minute) goes down, and congestive heart failure symptoms result.

Hypertension is one of the documented risk factors for ischemic heart disease (decreased blood to the heart muscle that results in anginal chest pain and heart attacks) because of the increased supply of oxygen needed by the thicker heart muscle. Hypertension is also associated with atherosclerosis, causing increased cholesterol deposits in the blood vessels of the heart.

Hypertensive heart disease is the leading cause of illness and death from hypertension. It affects approximately 7 out of 1,000 people.

Prevention:

Treat any known hypertension. Do not stop or change treatment except as advised by the health care provider. Monitor blood pressure as advised.

Symptoms:

It may take years for symptoms to develop from elevated blood pressure (hypertension). When heart disease develops, the symptoms are those of congestive heart failure or ischemic heart disease (angina or heart attack).

Congestive heart failure symptoms include:

• shortness of breath, especially with activity
• waking at night short of breath
• need to sleep with the head elevated to avoid shortness of breath
• rapid or irregular pulse
• sensation of feeling the heart beat (palpitations)
• cough, which may produce frothy or blood-tinged mucus
• fatigue, weakness, faintness
• swelling of the feet and ankles
• increased frequency of urination at night

Ischemic heart disease symptoms include:

• chest pain, pressure-type, particularly with exertion
• chest pain associated with:
  • nausea
  • sweating
  • dizziness
  • shortness of breath

Signs and Tests:

Signs of heart disease are found on physical examination. The blood pressure is elevated. Enlargement of the heart may be noted. There may be signs of heart failure including systemic (body) or pulmonary (lung) congestion. Listening to the chest with a stethoscope may reveal fluid in the lungs or abnormal heart sounds.

An ECG may be abnormal, showing an enlarged heart, an irregular heart beat, and/or evidence of ischemia (lack of oxygen to the heart muscle).

Enlargement of the heart or decreased heart functioning may be seen on:

• a chest X-ray
• a chest CT scan (rarely performed for this diagnosis)
• a
• coronary angiogram
• an echocardiogram

Treatment:

The goals of treatment are reduction of the blood pressure and control of the heart disease. Treatment of heart disease depends on the manifestation present (acute myocardial infarction, angina, heart failure, and so on).

Common medications include diuretics, potassium replacements, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, and direct vasodilators. Diazoxide and nitroprusside are intravenous medications that may be prescribed if hypertension is extremely severe and intensive care is necessary.

Blood pressure should be checked at regular intervals (as recommended by the health care provider) to monitor the condition. Frequent blood pressure measurements performed at home are often recommended for patients who have difficult-to-control high blood pressure. Diabetes, hyperlipidemia and other conditions that increase the risk of heart disease should be carefully controlled.

In addition to medications, lifestyle changes will be recommended, including weight loss, exercise, dietary adjustments to modify salt intake and/or consumption of saturated fats. If you smoke, stop smoking. Reduce or avoid consumption of alcohol. These habits greatly add to the effects of hypertension in causing heart disease.

Prognosis:

The extent of left ventricle enlargement (hypertrophy) is an indication of the risk for complications. Treatment of hypertension may reduce the amount of left ventricle damage. Recent studies have shown that certain medications such as the ACE inhibitors, beta-blockers, and the diuretic spironolactone can reverse left ventricular hypertrophy and/or prolong survival in patients with heart failure from hypertensive heart disease.

This disease can lead to sudden death.

Complications:

• heart failure
• arrhythmias
• myocardial infarction (tissue death)
• angina
• sudden death

Call your health care provider if hypertension has been diagnosed and symptoms develop.